HIV Stigma and Health Risks Among Sexually and Gender Diverse Youth in Thailand
HIV stigmatization is a process of devaluation of people living with (PLHIV), or associated with, HIV and AIDS. Important research has identified associations between HIV stigma and negative health outcomes and barriers to healthcare among PLHIV. Social psychological theory suggests that HIV stigma by association may exert negative impacts on HIV-negative individuals from marginalized populations; yet few investigations have explored HIV stigma among HIV-negative sexually and gender diverse youth (SGDY). Amidst an explosive HIV epidemic among gay men in Thailand, we assessed HIV stigma and correlates of stigma among high-risk HIV-negative and untested young gay and other men who have sex with men (MSM) and transgender women.
Methods
We used venue-based sampling to recruit high-risk MSM and transwomen, aged 18-30 years, from gay entertainment venues and community-based organizations in Chiang Mai and Pattaya. A 20-30 minute questionnaire was self-administered in Thai on Android tablet devices. We assessed sociodemographic characteristics; HIV risk and service utilization; and HIV stigma using two scales adapted for Asia. 11 items assessed felt-normative stigma (e.g., “In your community, how many people avoid visiting the homes of people with HIV?”); 10 items assessed vicarious stigma (e.g., “How often have you heard stories about people being mistreated by hospital workers because of their HIV-positive status?”). Stigma items were measured on a Likert scale from 0 (“Never”) to 3 (“Often”). We used multiple linear regression to determine the independent effects of HIV risk indicators and sociodemographics on felt-normative and vicarious stigma.
Results
Participants’ (n=389) median age was 25-years-old; 39.8% didn’t complete high school. The majority (54.2%) self-identified as gay, 24.9% transgender, 20.8% bisexual/heterosexual. 13.9% reported healthcare provider-diagnosed STI, past year. Two-thirds (67.0%) reported >3 male partners and 65.1% consistent condom use, past month. Over half (51.9%) were never tested for HIV. One-fifth (21.1%) reported forced sex (ever). The majority reported willingness to use a rectal microbicide (92.0%). The average felt-normative stigma score was 1.41 (SD=0.92) and vicarious stigma 0.84 (SD=0.67). Felt-normative stigma was associated with lower HIV testing rates (p=0.02) and lower microbicide acceptability (p=0.03). Vicarious stigma was associated with higher education (p<0.01), being gay or transgender (p=0.02), forced sex (p=0.02), higher number of partners (p<.05) and lower microbicide acceptability (p=0.04). In multivariable models, felt-normative stigma was 0.23 lower (95% CI -0.42, -0.05) among HIV-tested participants and 0.38 lower (95% CI -0.72, -0.04) among those reporting microbicide acceptability. Vicarious stigma was 0.13 lower (95% CI -0.27, -0.01) among HIV-tested participants, 0.29 lower (95% CI -0.54, -0.05) among those reporting microbicide acceptability, and higher among those with more education (high vs. low β=0.26, 95% CI 0.04, 0.48).
Conclusions and Implications
HIV stigma is associated with higher sexual risk and lower uptake of HIV preventive interventions among HIV-negative/untested community-recruited young gay men and transwomen in Thailand. Tailored interventions to reduce multifaceted HIV stigma in Thailand, in addition to benefits for PLHIV, may support evidence-informed HIV prevention among SGDY. Further social work research should assess the health impacts of HIV stigma and sexual stigma among SGDY in different sociocultural contexts.